1/25. brachial plexus lesions complicating anterior fracture-dislocation of the shoulder joint.Four cases of brachial plexus lesions caused by anterior fracture-dislocation of the shoulder are reported. The incidence, mechanism of injury and prognosis are reviewed.- - - - - - - - - - ranking = 1keywords = joint (Clic here for more details about this article) |
2/25. CT imaging and three-dimensional reconstructions of shoulders with anterior glenohumeral instability.Glenohumeral instability is a common occurrence following anterior dislocation of the shoulder joint, particularly in young men. The bony abnormalities encountered in patients with glenohumeral instability can be difficult to detect with conventional radiography, even with special views. The aim of our study was to evaluate the bony abnormalities associated with glenohumeral instability using CT imaging with 3-D reconstruction images. We scanned 11 patients with glenohumeral instability, one with bilateral symptoms; 10 were male, one female, and their ages ranged from 18-66 years. Contiguous 3 mm axial slices of the glenohumeral joint were taken at 2 mm intervals using a Siemens Somatom CT scanner. In the 12 shoulders imaged, we identified four main abnormalities. A humeral-head defect or Hill-Sachs deformity was seen in 83% cases, fractures of the anterior glenoid rim in 50%, periosteal new bone formation secondary to capsular stripping in 42%, and loose bone fragments in 25%. Manipulation of the 3-D images enabled the abnormalities to be well seen in all cases, giving a graphic visualization of the joint, and only two 3-D images were needed to demonstrate all the necessary information. We feel that CT is the imaging modality most likely to show all the bone abnormalities associated with glenohumeral instability. These bony changes may lead to the correct inference of soft tissue abnormalities making more invasive examinations such as arthrography unnecessary.- - - - - - - - - - ranking = 0.75keywords = joint (Clic here for more details about this article) |
3/25. Irreducible acute anterior dislocation of the shoulder caused by interposed fragment of the anterior glenoid rim.Failure of manipulative reduction of acute anterior dislocation of the shoulder is extremely rare. A 55-year-old man dislocated his right shoulder when he fell heavily. Initial radiographs and computed tomographs demonstrated an anterior dislocation with fracture of the glenoid rim. Several attempts at closed reduction were unsuccessful. At the time of open reduction, the cause of failure was found to be interposition of a fragment of the anterior inferior glenoid rim in the joint. To prevent redislocation, the fragment was held in place by two Herbert mini bone screws after anatomic reduction, and the ruptured subscapularis was reattached to the lesser tuberosity. Two and a half months after surgery, the shoulder was stable with full range of motion. To the best of our knowledge, this is the first reported case of interposition of a fracture-fragment of the anterior inferior glenoid rim causing failure of reduction.- - - - - - - - - - ranking = 0.25keywords = joint (Clic here for more details about this article) |
4/25. Posterior dislocation fractures of the shoulder in seizure disorders--two case reports and a review of literature.We present two patients with complaints of shoulder pain after an epileptic seizure. Both patients had a posterior dislocation fracture of the shoulder. After reviewing the literature the following conclusions can be drawn: (1) A posterior shoulder dislocation fracture is rare. (2) One should not underestimate the muscular forces in seizure disorders and be alert for dislocation fractures of the shoulder and/or other joints. (3) The diagnosis is frequently missed, but an axillary radiograph or a CT scan always reveals the fracture.- - - - - - - - - - ranking = 0.25keywords = joint (Clic here for more details about this article) |
5/25. Use of allograft for large Hill-Sachs lesion associated with anterior glenohumeral dislocation. A case report.Though Hill-Sachs lesion is a common injury associated with anterior glenohumeral dislocation, there have been only few articles describing specific treatments for the humeral head defects. This paper described the case of an alternative treatment for large defect of the posterior-superior aspect of the humeral head using allograft. The patient was a 69-year-old male and the diagnosis was a chronic anterior dislocation of the right glenohumeral joint with a large impaction fracture of the posterior-superior aspect of the humeral head. The size of this defect was 4 cm by 2.5 cm in diameter with a 2 cm depth. To reduce the impaction fracture of the humeral head, a preserved frozen allograft of the femoral head was selected and configured to fit the defect. The graft was then impacted firmly down into the defect, and appeared to offer excellent stability even without adjuvant internal fixation. Two years after surgery, the patient was doing quite well with no complaints. Radiographs showed humeral head with incorporation of the graft and no evidence of collapse.- - - - - - - - - - ranking = 0.25keywords = joint (Clic here for more details about this article) |
6/25. Arthroscopically treated proximal humeral fracture malunion.Articles describing the treatment of proximal humerus malunion are limited. Although in most of the cases, shoulder arthroplasty is the treatment of choice, when the articular surface of the humeral head is intact, other techniques can be considered and successfully used as well. Using arthroscopic techniques for proximal humerus malunion treatment is rarely reported in the literature. We could find only a few cases in which arthroscopic subacromial decompression was used to treat greater tuberosity malunion. Arthroscopic debridement and capsulotomy are also considered in the treatment of proximal humeral malunion cases with shoulder joint stiffness. This case report describes the completely arthroscopic treatment of a 4-part proximal humeral fracture malunion associated with pain and restricted range of motion. The main deformity in our case was medially displaced malunited lesser tuberosity that was blocking the internal rotation of the humerus. Isolated displaced lesser tuberosity fractures are rare injuries. Open techniques are usually the treatment of choice. We did not find any reports of arthroscopic treatment of lesser tuberosity malunion as a separate entity or as a component of a proximal humerus malunion. The early result in our case strongly encourages using arthroscopic techniques for lesser tuberosity malunion treatment as well as expanding the indications for shoulder arthroscopy in proximal humerus malunion cases.- - - - - - - - - - ranking = 0.25keywords = joint (Clic here for more details about this article) |
7/25. Arthroscopic treatment of gunshot wounds to the shoulder.Two cases are presented that demonstrate the utility of arthroscopic intervention for the management of gunshot wounds to the shoulder. The first report involves a 24-year-old man with a retained bullet in his glenohumeral joint after a drive-by shooting The intra-articular bullet was retrieved arthroscopically avoiding chondral injury from the mechanical effects of a loose body as well as the potential local and systemic effects of lead toxicity. Irrigation and debridement was performed to evacuate joint debris, which could have served as a nidus for infection or inflammation. The other case describes a 19-year-old man who sustained a gunshot wound to the lateral portion of his upper arm resulting in a proximal humerus fracture along with a retained bullet in his subacromial space. The bullet was successfully removed arthroscopically avoiding a traditional exposure, which would have complicated his fracture care.- - - - - - - - - - ranking = 0.5keywords = joint (Clic here for more details about this article) |
8/25. Treatment of limited shoulder motion: a case study based on biomechanical considerations.This article describes the management of a 57-year-old female patient following a fracture and dislocation of the right humeral head. The treatment of the patient involved the use of thermal agents, manual therapy, continuous passive motion, and splinting of the arm in an elevated position. We describe an approach to treatment of limited shoulder motion that is focused on identifying and applying tension to restricting structures rather than restoration of translatory gliding movements of the humeral head. Our treatment approach is based on recent data from biomechanical studies that challenge the concave-convex theory of arthrokinematic motion first described by MacConaill. We believe that tension in capsular tissues, rather than joint surface geometry, may control the translatory movements of the humeral head. The rationale for treatment involving low-load prolonged stress to tissues in the form of continuous passive motion and splinting is discussed as well as potential limitations of more brief forms of stress such as joint mobilization and manual stretching.- - - - - - - - - - ranking = 0.5keywords = joint (Clic here for more details about this article) |
9/25. brachial plexus injury with erect dislocation of the shoulder.Luxatio erecta, or inferior dislocation of the glenohumeral joint, is an extremely uncommon variety of shoulder dislocation. Several types of neurovascular injuries may be associated with luxatio erecta. Concomitant fracture of the coracoid, clavicle, acromion, greater tuberosity, and humeral head may also be noted. A case of luxatio erecta associated with a fracture of the greater tuberosity and transient mixed brachial plexus injuries is presented.- - - - - - - - - - ranking = 0.25keywords = joint (Clic here for more details about this article) |
10/25. Avascular necrosis of the humeral head after dislocation with fracture of the greater tuberosity.A case of posttraumatic avascular necrosis of the humeral head in a young patient was detected 3 years after an anterior dislocation with a nondisplaced greater tuberosity fracture. The evolution to degenerative joint disease is described.- - - - - - - - - - ranking = 0.25keywords = joint (Clic here for more details about this article) |
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